DELIRIUM IN PERSONS WITH DEMENTIA

描述（由申请人提供）：到2050年，预计美国有1400万老年人患有痴呆症。众所周知，痴呆症患者发生谵妄或急性意识模糊状态的风险增加。此外，目前的证据表明，谵妄可能会恶化痴呆的预后，可能会改变认知功能下降的临床过程和轨迹，并可能与长期结果严重恶化。然而，谵妄叠加痴呆（DSD）的问题仍然是一个被忽视的临床研究领域。该研究是一项前瞻性队列研究设计，涉及165名65岁及以上的痴呆住院受试者，包括3个月的随访期。我们这项研究的目的是：1）确定DSD的危险因素，2）描述DSD的住院后结局和认知下降的轨迹，这将证明痴呆患者谵妄的适当预防和管理策略的发展是合理的。从入院到出院每天评估谵妄，然后在1个月和3个月随访时使用意识模糊评估方法（CAM）进行评估。将检查的潜在风险因素分为相关变量的3个主轴，包括：1）多种药物（中枢神经系统活性药物、药物数量、添加的新药物），2）身体压力（尿路感染、疼痛、脱水）和3）环境压力（卧床休息、约束、房间变化）。将测量的主要结局包括：住院时间、认知功能下降和功能状态。将由对研究目的不知情的研究人员评估结局。其他基线测量工具将包括Folstein简易精神状态检查（MMSE）、老年人认知功能减退知情人问卷（IQCODE）、康奈尔抑郁量表、谵妄评定量表（DRS-R-98）、Katz ADL量表、Lawton工具性日常生活活动量表（IADL）、Charlson共病指数、Apache II、临床痴呆评定量表（CDR）、家庭半结构化访谈表、和一个改良的祝福量表将利用多元逻辑回归、协方差分析和混合模型重复测量分析来分析风险因素和结局，以检查诊断为DSD的患者与仅在基线时患有痴呆的患者之间的差异。我们的长期目标是利用这项研究的结果来设计和测试干预策略，以改善DSD患者的早期识别，管理，预防和结局。这项研究针对的是痴呆症患者中日益严重的可预防问题的公共卫生问题。最终，这项研究和后续研究的结果应该通过减少与谵妄相关的并发症和住院治疗来改善痴呆症患者及其护理人员的生活。

DESCRIPTION (provided by applicant): By 2050, 14 million older persons in the United States are expected to have dementia. It is well known that persons with dementia are at increased risk of developing delirium or acute confusional state. Further, current evidence suggests that delirium may worsen the prognosis of dementia, may alter the clinical course and trajectory of cognitive decline, and may be associated with substantially worse long-term outcomes. However, the problem of delirium superimposed on dementia (DSD) remains a neglected area of clinical investigation. The proposed study is a prospective cohort study design involving 165 hospitalized subjects with dementia who are 65 and older and includes a 3-month follow-up period. Our aims for this study are: 1) to identify risk factors for DSD, and 2) to describe post-hospital outcomes and the trajectory of cognitive decline for DSD, which will justify the development of appropriate preventive and management strategies for delirium in patients with dementia. Delirium will be assessed daily from admission to discharge and then at 1 and 3 month follow-up using the Confusion Assessment Method (CAM). The potential risk factors that will be examined are divided into 3 major axes of related variables, including: 1) polypharmacy (central nervous system-active medications, number of medications, new medications added), 2) physical stressors (urinary tract infection, pain, dehydration), and 3) environmental stressors (bedrest, restraints, room changes). The primary outcomes which will be measured include: hospitalization length of stay, cognitive decline, and functional status. Outcomes will be assessed by research staff blinded to the study aims. Other baseline measurement tools will include the Folstein Mini-Mental State Examination (MMSE), Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Cornell Depression Scale, Delirium Rating Scale (DRS-R-98), Katz ADL Scale, Lawton Instrumental Activities of Daily Living Scale (IADL), Charlson Co-morbidity Index, Apache II, the Clinical Dementia Rating scale (CDR), a family semi-structured interview form, and a Modified Blessed Scale. Risk factors and outcomes will be analyzed utilizing multiple logistic regression, analysis of covariance, and mixed model repeated measures analyses to examine differences between those diagnosed with DSD and those with dementia only at baseline. Our long-term objectives are to use the results from this study to design and test an intervention strategy to improve early recognition, management, prevention, and outcomes in persons with DSD. This research targets a growing public health problem of preventable problems in persons with dementia. Ultimately, the results from this and subsequent studies should improve the lives of persons with dementia and their caregivers by decreasing delirium-related complications and hospitalizations.